1
|
Guest D, Gous G, Butcher A, Mackenzie A, Guest G, Young A, Crundall D. Developing a taxonomy of hazards and hazard mitigation strategies for Motorised mobility scooter users. ACCIDENT; ANALYSIS AND PREVENTION 2024; 195:107423. [PMID: 38081092 DOI: 10.1016/j.aap.2023.107423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 12/30/2023]
Abstract
The increased use of motorised mobility scooters (MMSs) presents a road safety challenge as using a MMS has risks for the user, pedestrians, and other road users. In relation to enhancing MMS driving safety, much of the training and available literature focuses on training vehicular control. Equally important is the need to investigate higher-order cognitive skills involved in driving MMSs, particularly hazard perception. Through a large questionnaire study with MMS users, we develop a taxonomy of the types of hazard MMS users encounter when crossing roads and strategies that are used to negotiate these hazards. Whilst MMS experience modulated hazard perception and strategy use, a core set of hazards and strategies were identified that have policy and practice implications for training interventions and the built environment. Exploration of the advantages and disadvantages of MMS use indicated its impact on various wellbeing outcomes as well as some potential barriers to use.
Collapse
|
2
|
Kirby RL, Smith C, Mortenson WB, Battalova A, Hurd L, Hobson S, Jang S, Emery R. Qualitative experiences of new motorised mobility scooter users relevant to their scooter skills: a secondary analysis. Disabil Rehabil Assist Technol 2023; 18:89-96. [PMID: 35442822 DOI: 10.1080/17483107.2022.2063422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To explore the experiences of new motorised mobility scooter users from the perspectives of the assessment and training of scooter skills. DESIGN Descriptive secondary analysis of qualitative data. SETTING Community. PARTICIPANTS 20 New users of motorised mobility scooters. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Directed qualitative analysis of up to four semi-structured interviews over the course of the first year of scooter use, to identify themes and sub-themes that could inform recommendations regarding assessment and training protocols. RESULTS We identified two themes. The first related to potential new content. As one example of the sub-themes, there were many excerpts that dealt with the use of skills in various combinations and permutations that were used to carry out activities during everyday life and participate in society. These excerpts suggested the importance of training skills in combination to facilitate skill transfer (or generalizability). The second theme is related to enhancements of existing content. As one example of the sub-themes, there were several excerpts that dealt with scooter security. These excerpts led to the recommendation that removing and inserting the scooter key should be added to the assessment criteria for the "turns power on and off" skill of the Wheelchair Skills Test (WST) and its questionnaire version (WST-Q). CONCLUSIONS The experiences of scooter users over the first year of receiving a scooter appear to be relevant to the assessment and training of scooter skills and suggest themes for further study. Clinical trial registration number: NCT02696213 IMPLICATIONS FOR REHABILITATIONThe experiences of new scooter users are highly relevant to the assessment and training of scooter skills.These experiences suggest both potential new content and enhancements of existing content to the Wheelchair Skills Program Manual.
Collapse
Affiliation(s)
- R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Canada
| | - Cher Smith
- Department of Occupational Therapy, Nova Scotia Health Authority, Halifax, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, Canada
| | - Alfiya Battalova
- School of Kinesiology, The University of British Columbia, Vancouver, Canada
| | - Laura Hurd
- School of Kinesiology, The University of British Columbia, Vancouver, Canada
| | - Sandra Hobson
- School of Occupational Therapy, University of Western Ontario, London, Canada
| | - Sharon Jang
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, Canada
| | - Richelle Emery
- Vancouver Coastal Health - Community Care, Vancouver, Canada
| |
Collapse
|
3
|
Suzurikawa J, Kurokawa S, Sugiyama H, Hase K. Estimation of Steering and Throttle Angles of a Motorized Mobility Scooter with Inertial Measurement Units for Continuous Quantification of Driving Operation. SENSORS (BASEL, SWITZERLAND) 2022; 22:3161. [PMID: 35590851 PMCID: PMC9103857 DOI: 10.3390/s22093161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 02/04/2023]
Abstract
With the growing demand from elderly persons for alternative mobility solutions, motorized mobility scooters (MMSs) have been gaining importance as an essential assistive technology to aid independent living in local communities. The increased use of MMSs, however, has raised safety issues during driving and magnified the necessity to evaluate and improve user driving skills. This study is intended to develop a novel quantitative monitoring method for MMS driving operation using inertial measurement units (IMUs). The proposed method used coordinate transformations around the rotational axes of the steering wheel and the throttle lever to estimate the steering and throttle operating angles based on gravitational accelerations measured by IMUs. Consequently, these operating angles can be monitored simply using an IMU attached to the throttle lever. Validation experiments with a test MMS in the stationary state confirmed the consistency of the proposed coordinate transformation with the MMS's geometrical structure. The driving test also demonstrated that the operating angles were estimated correctly on various terrains and that the effects of terrain inclination were compensated using an additional IMU attached to the scooter body. This method will be applicable to the quantitative monitoring of driving behavior and act as a complementary tool for the existing skills' evaluation methods.
Collapse
Affiliation(s)
- Jun Suzurikawa
- Department of Assistive Technology, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa-shi 359-8555, Japan; (S.K.); (H.S.)
| | - Shunsuke Kurokawa
- Department of Assistive Technology, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa-shi 359-8555, Japan; (S.K.); (H.S.)
- Department of Mechanical Systems Engineering, Graduate School of Systems Design, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi 192-0397, Japan;
| | - Haruki Sugiyama
- Department of Assistive Technology, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa-shi 359-8555, Japan; (S.K.); (H.S.)
- Department of Mechanical Systems Engineering, Graduate School of Systems Design, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi 192-0397, Japan;
| | - Kazunori Hase
- Department of Mechanical Systems Engineering, Graduate School of Systems Design, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi 192-0397, Japan;
| |
Collapse
|
4
|
Brassel S, Power E, Campbell A, Brunner M, Togher L. Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review. J Med Internet Res 2021; 23:e26344. [PMID: 34328434 PMCID: PMC8367177 DOI: 10.2196/26344] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/25/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. OBJECTIVE This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. METHODS This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. RESULTS In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. CONCLUSIONS There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area.
Collapse
Affiliation(s)
- Sophie Brassel
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Power
- Speech Pathology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Campbell
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Melissa Brunner
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
5
|
Mortenson WB, Battalova A, Hurd L, Hobson S, Emery R, Kirby RL. Correlates of self-reported Wheelchair Skills Test Questionnaire scores of new users of mobility scooters: a cross-sectional study. Disabil Rehabil Assist Technol 2021:1-8. [PMID: 33503387 DOI: 10.1080/17483107.2021.1874065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To describe the subjective reported scooter-skill scores of new mobility scooter users and to identify significant correlations with other characteristics and measures. MATERIALS AND METHODS This was a single-centre study using a cross-sectional design. Participants (N = 22) completed the Wheelchair Skills Test-Questionnaire (WST-Q) Version 4.3 for scooter users. It measures the users' perceived capacity (what the user can do), performance (what the user actually does), and confidence (or self-efficacy). Their scooter skills were also rated objectively with the Wheelchair Skills Test (WST). They completed standardised measures of cognition, hearing, vision, life space mobility, visual attention and task switching, and confidence negotiating the social environment using their scooters. RESULTS Mean total WST-Q capacity scores were 83% and performance scores were 25%. WST-Q capacity scores had significant positive correlations with WST-Q performance (r = 0.321) and confidence scores (r = 0.787), WST capacity scores (r = 0.488), and confidence negotiating the social environment (WheelCon) (r = 0.463). WST-Q capacity scores were significantly negatively correlated with Trail Making B scores (r = -0.591) and age (r = -0.531). CONCLUSIONS The correlations between WST-Q scores and other variables are similar to those found in other studies among users of scooters and other mobility devices. The gap between capacity and performance scores highlights the needs for additional skills training in this population of novice scooter users.IMPLICATIONS FOR REHABILITATIONIn implementing scooter training for new scooter users, attention should be paid to building community-based skills for navigating both the physical and the social environment.Scooter users' age and their driving capabilities need to be taken into account when developing and delivering the training.
Collapse
Affiliation(s)
- W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Alfiya Battalova
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Laura Hurd
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Sandra Hobson
- School of Occupational Therapy, University of Western Ontario, London, Canada
| | - Richelle Emery
- Vancouver Coastal Health - Community Care, Vancouver, Canada
| | - R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Canada
| |
Collapse
|
6
|
Momma H, Suzurikawa J, Takeshima R, Sawada Y, Harada Y, Kondo T. Assessment of driving skills of a mobility scooter using driving operation logs. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3212-3215. [PMID: 33018688 DOI: 10.1109/embc44109.2020.9176296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A mobility scooter is a major assistive technology that replaces human ambulatory functions for people with disabilities. A license is often not required for driving a mobility scooter; therefore, less skilled drivers might create safety concerns. An effective way of reducing these safety risks is by assessing the driving skills of users. The existing assessment measures mostly score the task performance using manual observations. In this study, we have developed a novel assessment system that logs the driving operations by using add-on sensors. This system can monitor the operations of a mobility scooter including the angles of the throttle lever and the steering tiller. The subjects were seven older adults who participated in the driving test involving six tasks; the driver performances were video recorded, and the vehicle operation data were logged. The video analysis showed that two subjects crashed their scooters into objects or made contact with objects during the test course. To extract the characteristic patterns of the operations from the logs, 2D histograms of the operational status durations were investigated for each subject and task. Subsequent analysis of the operation logs identified the two subjects who had crashed their vehicles during the test drive. Our results proved that the driving operation logs could be used complementarily as a simple and low-cost tool for assessing a person's driving skills.
Collapse
|
7
|
Morère Y, Bourhis G, Cosnuau K, Guilmois G, Rumilly E, Blangy E. ViEW: A wheelchair simulator for driving analysis. Assist Technol 2020; 32:125-135. [PMID: 30085901 DOI: 10.1080/10400435.2018.1503204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The powered wheelchair (PW) has become an essential mobility assistive technology for people with motor disabilities. A critical step involved in maximizing the end-user experience is evaluating individual functional abilities. Using powered wheelchair simulation for driving analysis offers flexibility for safely evaluating the individual's driving performance in a variable environment and situations ranging in difficulty. Additionally, it makes it possible to measure numerous variables involved in the driving process. The main objectives of this pilot study were to assess PW users' outdoor driving abilities to study how the simulator can improve outdoor driving task performance, and to define new objective criteria for evaluating the overall driving process. The study presented involved a group of 12 children and young adults diagnosed with cerebral palsy. Simulations were conducted using ViEW (Virtual Electrical Wheelchair), a 3D wheelchair simulator designed in our laboratory. A customized virtual environment was designed to immerse the user in a life-like driving experience. We used the data collected on the simulator to define driving skills indicators. The acquired skills during simulations were transferable to on-road wheelchair driving. The participants' performance indicators produced positive results. Computed performance indicators can be a valuable decision-making tool for occupational therapists.
Collapse
Affiliation(s)
- Yann Morère
- LCOMS, Lorraine University, Metz-Technopole, France
| | - Guy Bourhis
- LCOMS, Lorraine University, Metz-Technopole, France
| | - Kévin Cosnuau
- Centre de Médecine Physique de Réadaptation pour Enfants, IRR de Nancy, Flavigny sur Moselle, France
| | - Georges Guilmois
- Centre de Médecine Physique de Réadaptation pour Enfants, IRR de Nancy, Flavigny sur Moselle, France
| | - Emilie Rumilly
- Centre de Médecine Physique de Réadaptation pour Enfants, IRR de Nancy, Flavigny sur Moselle, France
| | - Emmanuelle Blangy
- Centre de Médecine Physique de Réadaptation pour Enfants, IRR de Nancy, Flavigny sur Moselle, France
| |
Collapse
|
8
|
Ku FL, Chen WC, Chen MD, Tung SY, Chen TW, Tsai CC. The determinants of motorized mobility scooter driving ability after a stroke. Disabil Rehabil 2020; 43:3701-3710. [PMID: 32297816 DOI: 10.1080/09638288.2020.1748125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To investigate the determinants related to the ability to drive a motorized mobility scooter after a stroke.Method: The study was a cross-sectional study. The ability to drive a motorized mobility scooter was measured with the Power Mobility Clinical Driving Assessment. The independent variables included cognitive functions measured by the Color Trails Test and reaction time test, visual functions measured by a visual acuity test and visual field test, and motor functions measured with a dynamometer, the Box and Block Test, and the Functional Independence Measure.Results: The correlation analyses revealed that the Power Mobility Clinical Driving Assessment scores had significant correlations with reaction time (ρ = -.65, p < 0.01), binocular visual field (r = .64, p < 0.01), binocular visual acuity (r = .40, p = 0.03), and the grip strength of the unaffected hand (r = .47, p = 0.01). The multiple regression analysis indicated that reaction time, binocular visual field, and the grip strength of the unaffected hand were the most significant determinants of the ability to drive a motorized mobility scooter (R2 = .76).Conclusions: The reaction time, binocular visual field, and grip strength of the unaffected hand were the most significant determinants related to the ability to drive a motorized mobility scooter after a stroke. IMPLICATIONS FOR REHABILITATIONMotorized mobility scooter driving ability for stroke patients is correlated with demographics (age, mobility scooter driving experience, time since last drive) and cognitive, visual and motor functions (reaction time, binocular visual field, visual acuity, and the grip strength of unaffected hand).Primary determinants of motorized mobility scooter driving ability for stroke patients include reaction time, binocular visual field, and grip strength of the unaffected hand.Comprehensive assessments incorporating cognitive, visual and motor functions are needed to evaluate the ability to drive a motorized mobility scooter after a stroke.
Collapse
Affiliation(s)
- Fang-Ling Ku
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wei-Chung Chen
- Department of Traditional Chinese Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-De Chen
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Szu-Ya Tung
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Tien-Wen Chen
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Chiu-Chin Tsai
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| |
Collapse
|
9
|
Brandt Å, Hansen EM, Christensen JR. The effects of assistive technology service delivery processes and factors associated with positive outcomes - a systematic review. Disabil Rehabil Assist Technol 2019; 15:590-603. [PMID: 31703540 DOI: 10.1080/17483107.2019.1682067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The objective of this systematic review was to investigate effects of different assistive technology service delivery processes (AT-SDPs) for people with functional limitations, including investigation of factors associated with positive outcomes.Materials and methods: The study was registered in PROSPERO, registration number CRD42018097030. Included were quantitative studies published in peer reviewed journals: randomized controlled trials, cohort, case-control and analytical cross-sectional studies investigating effects of different AT-SDPs or factors associated with the AT-SDP and with n ≥ 10 participants. A systematic literature search was carried out in the databases PsycINFO, CINAHL, SSCI and Medline from 1 January 2008 to 25 July 2018. Besides, four journals were hand searched. The Joanna Briggs Institute MAStARI Critical Appraisal Tools were utilized to assess the risk of bias.Results: The search resulted in a total of 2947 references of which 12 articles representing 10 studies were included. Five studies were experimental, two were cohort, and five were cross-sectional studies.Conclusions: This systematic review confirms previous findings that assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes. The level of evidence is, however, low, and it is not clear which of the applied methods are most effective. The review also gives some indication that new technologies could be used to improve the AT-SDP and reduce costs and that training in using the assistive devices seems to be useful. Even though some evidence of effective AT-SDP methods has been identified, more research is still needed to give valid recommendations to AT-SDP practice.Implications for rehabilitationAssistive technology users should be involved in the AT-SDP in order to achieve positive outcomes, but it cannot be determined which methods are the most effective.New digital technologies could be used to improve the AT-SDP and reduce costs.Training of the users in using their devices is probably useful, but since no specific methods nor extent or dose can be recommended, the professionals still need to use their clinical experience and reasoning to assess the user's needs for training.
Collapse
Affiliation(s)
- Åse Brandt
- Centre for Disability and Mental Vulnerability, The National Board of Social Services, Odense, Denmark.,The Research Initiative for Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Else Marie Hansen
- Centre for Disability and Mental Vulnerability, The National Board of Social Services, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- The Research Initiative for Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
10
|
Carlsson A, Lundälv J. Acute injuries resulting from accidents involving powered mobility devices (PMDs)-Development and outcomes of PMD-related accidents in Sweden. TRAFFIC INJURY PREVENTION 2019; 20:484-491. [PMID: 31180723 DOI: 10.1080/15389588.2019.1606910] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/17/2019] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
Objective: Powered mobility devices (PMDs) are commonly used as aids for older people and people with disabilities, subgroups of vulnarable road users (VRUs) who are rarely noted in traffic safety contexts. However, the problem of accidents involving PMD drivers has been reported in many countries where these vehicles have become increasingly popular. The aim of this study is to extract and analyze national PMD-related accident and injury data reported to the Swedish Traffic Accident Data Acquisition (STRADA) database. The results will provide valuable insight into the risks and obstacles that PMD drivers are exposed to in the traffic environment and may contribute to improving the mobility of this group in the long term. Methods: The current study is based on data from 743 accidents and 998 persons. An analysis was performed on a subset of data (N = 301) in order to investigate the development of accidents over a period of 10 years. Thereafter, each accident in the whole data set was registered as either single (N = 427) or collision (N = 315). Results: The results show that there was a 3-fold increase in the number of PMD-related accidents reported to STRADA during the period 2007-2016. With regard to single accidents, collisions, as well as fatalities, the injury statistics were dominated by males. Single accidents were more common than collisions (N = 427 and N = 316, respectively) and the level of injury sustained in each type of accident is on par. The vast majority of single accidents resulted in the PMD driver impacting the ground (87%), due to either PMD turnover (71%) or the driver falling out of the PMD (16%). The reason for many of the single accidents was a difference in ground level (34%, typically a curb). Cars, trucks, or buses were involved in 67% of collision events; these occured predominantly at junctions or intersections (70%). Abbreviated Injury Scale (AIS) 3+ injuries were dominated by hip and head injuries in both single accidents and collision events. Conclusions: The present study shows that further research on PMD accidents is required, with regard to both single accidents and collision events. To ensure that appropriate decisions are made, future work should follow up on injury trends and further improve the quality of PDM-related accident data. Improved vehicle stability and design, increased usage of safety equipment, proper training programs, effective maintenance services, and development of a supporting infrastructure would contribute to increased safety for PMD drivers.
Collapse
Affiliation(s)
- Anna Carlsson
- a Commercial R&D, Chalmers Industrial Technology , Gothenburg , Sweden
| | - Jörgen Lundälv
- b Department of Social Work , University of Gothenburg , Gothenburg , Sweden
- c Department of Surgical and Perioperative Sciences , Unit of Surgery, Umeå University , Umeå , Sweden
| |
Collapse
|
11
|
Cordes C, Heutink J, Brookhuis KA, Brouwer WH, Melis-Dankers BJ. Driving slow motorised vehicles with visual impairment—A simulator study. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1485473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Christina Cordes
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Knowledge, Innovation & Expertise, Huizen, the Netherlands
| | - Joost Heutink
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Knowledge, Innovation & Expertise, Huizen, the Netherlands
| | - Karel A. Brookhuis
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - Wiebo H. Brouwer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - Bart J.M. Melis-Dankers
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Rehabilitation & Advice, Haren, the Netherlands
| |
Collapse
|
12
|
Ku J, Kang YJ. Novel Virtual Reality Application in Field of Neurorehabilitation. BRAIN & NEUROREHABILITATION 2018. [DOI: 10.12786/bn.2018.11.e5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jeonghun Ku
- Department of Biomedical Engineering, College of Medicine, Keimyung University, Daegu, Korea
| | - Youn Joo Kang
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| |
Collapse
|
13
|
Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. OBJECTIVES Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. SELECTION CRITERIA Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. MAIN RESULTS We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard-care approach. PRIMARY OUTCOME results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) -0.05 to 0.20, 22 studies, 1038 participants, low-quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low-quality evidence). SECONDARY OUTCOMES when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty-three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild. AUTHORS' CONCLUSIONS We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.
Collapse
Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | - Belinda Lange
- Flinders UniversitySchool of Health Sciences, Discipline of PhysiotherapyAdelaideAustralia
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | - Judith E Deutsch
- Rutgers UniversityDepartment of Rehabilitation and Movement ScienceNewarkNew JerseyUSA
| | - Gustavo Saposnik
- University of TorontoDepartment of Medicine (Neurology), St Michael's HospitalTorontoCanadaM5C 1R6
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | | |
Collapse
|
14
|
Mortenson WB, Jang S, Goldsmith CH, Hurd Clarke L, Hobson S, Emery R. Feasibility of a Systematic, Comprehensive, One-to-One Training (SCOOT) program for new scooter users: study protocol for a randomized control trial. Trials 2017; 18:235. [PMID: 28545498 PMCID: PMC5445361 DOI: 10.1186/s13063-017-1963-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/02/2017] [Indexed: 11/14/2022] Open
Abstract
Background Mobility scooters can facilitate community participation among individuals with mobility limitations. However, accidents are a serious concern with scooter use. Scooter training has been recommended to improve safety, but there are currently few validated programs available. Therefore, we developed a Systematic, Comprehensive, One-to-One Training (SCOOT) program for scooter users. We will conduct a study to evaluate the outcomes produced by the provision SCOOT. Methods This feasibility study will use a mixed-methods, rater-blinded, randomized control trial, with a two-step wedge design. The study has two arms: an immediate intervention group, which will receive the intervention directly after baseline assessments, and a delayed intervention group, which will receive the intervention after a 6-week period. Forty participants, who will be stratified based on whether or not participants have previously held a driver’s license, will be randomly assigned to each arm. The intervention for this study consists of 6 weeks of one-to-one scooter training by an experienced occupational therapist, who will provide training once or twice per week over the 6 weeks. The primary outcome measure is subjective scooter skills, measured using the Wheelchair Skills Test for scooters. Secondary outcomes include objective scooter skills, confidence, mobility, and satisfaction with selected participation activities. Descriptive measures include cognitive status, functional status, hearing, vision, physical accessibility of the home and community, and visual attention and task switching. Qualitative interviews will be conducted with the first ten willing participants from each group to learn about their scooter use and experiences with SCOOT. Discussion The results of this study will inform a larger randomized control trial. If the intervention is proven to be effective in this larger study, it may have important implications for policy and practice. Trial registration ClinicalTrials.gov identifier: NCT02696213. Registered on 23 February 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1963-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- W Ben Mortenson
- The Department of Occupational Science and Occupational Therapy, University of British Columbia, T-325-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Sharon Jang
- GF Strong Rehabilitation Center, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada
| | - Charlie H Goldsmith
- Mary Pack Arthritis Center, 895 West 10th Ave., Vancouver, BC, V5Z 1L7, Canada
| | - Laura Hurd Clarke
- University of British Columbia, 1924 West Mall, Vancouver, BC, V6T 1Z2, Canada.,School of Kinesiology, University of British Columbia, 1156-1924 West Mall, Vancouver, BC, V6T 1Z2, Canada
| | - Sandra Hobson
- University of Western Ontario, 1201 Western Road, London, ONT, N6G 1H1, Canada
| | - Richelle Emery
- Vancouver Coastal Health - Community Care, 520 West 6th Avenue, Vancouver, BC, V5Z 1A1, Canada
| |
Collapse
|
15
|
Mortenson WB, Hurd Clarke L, Goldsmith CH, Jang S, Kirby RL. Measurement properties of the Wheelchair Skills Test for scooters among experienced users. Disabil Rehabil Assist Technol 2017; 13:60-65. [PMID: 28164718 DOI: 10.1080/17483107.2017.1280546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the score distribution, reliability, and validity of the objective Wheelchair Skills Test (WST) for scooter users. METHOD A study using a test-retest design was conducted with 20 people who had mobility limitations that prevented them from ambulating more than one city block without a mobility aid, and who had owned a scooter for ≥3 months. Objective scooter skills, confidence, and physical accessibility were measured at both time points, while anxiety, depression, visual attention and task switching, functional independence, and visual acuity were measured only at baseline. RESULTS The mean total WST scores at Time 1 and Time 2 were 86.3% and 87.5%. The WST ICC was 0.889. The WST had a SEM of 2.50 and a Cronbach's alpha of 0.74. The total WST scores were significantly correlated with total subjective WST-Q scores (r = 0.547, p = 0.013), scooter confidence (r = 0.466, p = 0.038), and were affected by gender (p = 0.005). CONCLUSION The WST for scooters has good test-retest reliability and generally varies as anticipated with other measures. Although further study is needed, the WST for scooters appears to have promise for use in research and clinical practice. Implications for Rehabilitation It is important to understand the measurement properties of the tools we use in rehabilitation so the results can be interpreted correctly. As scooter use increases, better measurement of skills is required.
Collapse
Affiliation(s)
- W Ben Mortenson
- a Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , BC , Canada.,b International Collaboration on Repair Discoveries (ICORD), UBC Faculty of Medicine and Vancouver Coastal Health (VCH) Research Institute , Vancouver , BC , Canada.,c Rehabilitation Research Program, VCH Research Institute , Vancouver , BC , Canada
| | - Laura Hurd Clarke
- d School of Kinesiology , University of British Columbia , Vancouver , BC , Canada
| | - Charlie H Goldsmith
- a Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , BC , Canada.,e Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Sharon Jang
- b International Collaboration on Repair Discoveries (ICORD), UBC Faculty of Medicine and Vancouver Coastal Health (VCH) Research Institute , Vancouver , BC , Canada.,c Rehabilitation Research Program, VCH Research Institute , Vancouver , BC , Canada
| | - R Lee Kirby
- f Division of Physical Medicine and Rehabilitation, Department of Medicine , Dalhousie University , Halifax , NS , Canada
| |
Collapse
|
16
|
Interrater Reliability of the Power Mobility Road Test in the Virtual Reality–Based Simulator-2. Arch Phys Med Rehabil 2016; 97:1078-84. [DOI: 10.1016/j.apmr.2016.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 11/24/2022]
|
17
|
Ben Mortenson W, Kim J. Scoping review of mobility scooter-related research studies. ACTA ACUST UNITED AC 2016; 53:531-540. [DOI: 10.1682/jrrd.2015.05.0084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/03/2015] [Indexed: 11/05/2022]
Affiliation(s)
- W. Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada; International Collaboration on Repair Discoveries, Vancouver, Canada; and Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada;GF Strong Rehabilitation Research Program, Vancouver, Canada
| | - Jenny Kim
- GF Strong Rehabilitation Research Program, Vancouver, Canada
| |
Collapse
|
18
|
Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles have been rapidly adopted in clinical settings. This is an update of a Cochrane Review published in 2011. PRIMARY OBJECTIVE To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. SECONDARY OBJECTIVE To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance activity, global motor function, cognitive function, activity limitation, participation restriction and quality of life, voxels or regions of interest identified via imaging, and adverse events. Additionally, we aimed to comment on the feasibility of virtual reality for use with stroke patients by reporting on patient eligibility criteria and recruitment. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (October 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 11), MEDLINE (1950 to November 2013), EMBASE (1980 to November 2013) and seven additional databases. We also searched trials registries and reference lists. SELECTION CRITERIA Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance function and activity, and global motor function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted investigators to obtain missing information. MAIN RESULTS We included 37 trials that involved 1019 participants. Study sample sizes were generally small and interventions varied. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains 'low' or 'very low' quality when rated using the GRADE system. Control groups received no intervention or therapy based on a standard care approach. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. PRIMARY OUTCOME results were statistically significant for upper limb function (standardised mean difference (SMD) 0.28, 95% confidence intervals (CI) 0.08 to 0.49 based on 12 studies with 397 participants). SECONDARY OUTCOMES there were no statistically significant effects for grip strength, gait speed or global motor function. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.43, 95% CI 0.18 to 0.69 based on eight studies with 253 participants); however, we were unable to pool results for cognitive function, participation restriction, quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 26% of participants screened were recruited. AUTHORS' CONCLUSIONS We found evidence that the use of virtual reality and interactive video gaming may be beneficial in improving upper limb function and ADL function when used as an adjunct to usual care (to increase overall therapy time) or when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength, gait speed or global motor function. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term.
Collapse
Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
| | - Susie Thomas
- University of South Australia (City East)International Centre for Allied Health Evidence (iCAHE)GPO Box 2471AdelaideAustralia5000
| | - Judith E Deutsch
- Rutgers UniversityDepartment of Rehabilitation and Movement ScienceNewarkUSA
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
| |
Collapse
|
19
|
Kamaraj DC, Dicianno BE, Cooper RA. A participatory approach to develop the Power Mobility Screening Tool and the Power Mobility Clinical Driving Assessment tool. BIOMED RESEARCH INTERNATIONAL 2014; 2014:541614. [PMID: 25276796 PMCID: PMC4172927 DOI: 10.1155/2014/541614] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/28/2014] [Accepted: 08/05/2014] [Indexed: 11/18/2022]
Abstract
The electric powered wheelchair (EPW) is an indispensable assistive device that increases participation among individuals with disabilities. However, due to lack of standardized assessment tools, developing evidence based training protocols for EPW users to improve driving skills has been a challenge. In this study, we adopt the principles of participatory research and employ qualitative methods to develop the Power Mobility Screening Tool (PMST) and Power Mobility Clinical Driving Assessment (PMCDA). Qualitative data from professional experts and expert EPW users who participated in a focus group and a discussion forum were used to establish content validity of the PMCDA and the PMST. These tools collectively could assess a user's current level of bodily function and their current EPW driving capacity. Further multicenter studies are necessary to evaluate the psychometric properties of these tests and develop EPW driving training protocols based on these assessment tools.
Collapse
Affiliation(s)
- Deepan C. Kamaraj
- VA Center of Excellence in Wheelchairs and Related Technology, VA Pittsburgh Healthcare System and Human Engineering Research Laboratories, Pittsburgh, PA 15206, USA
- Human Engineering Research Laboratories,
6425 Penn Avenue, Bakery Square, Suite 400, Pittsburgh, PA 15206, USA
| | - Brad E. Dicianno
- VA Center of Excellence in Wheelchairs and Related Technology, VA Pittsburgh Healthcare System and Human Engineering Research Laboratories, Pittsburgh, PA 15206, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rory A. Cooper
- VA Center of Excellence in Wheelchairs and Related Technology, VA Pittsburgh Healthcare System and Human Engineering Research Laboratories, Pittsburgh, PA 15206, USA
- Human Engineering Research Laboratories,
6425 Penn Avenue, Bakery Square, Suite 400, Pittsburgh, PA 15206, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
20
|
Toosizadeh N, Bunting M, Howe C, Mohler J, Sprinkle J, Najafi B. Motorized mobility scooters: the use of training/intervention and technology for improving driving skills in aging adults - a mini-review. Gerontology 2014; 60:357-65. [PMID: 24481257 DOI: 10.1159/000356766] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Motorized mobility scooters (MMS) have become the most acceptable powered assistive device for those with impaired mobility, who have sufficient upper body strength and dexterity, and postural stability. Although several benefits have been attributed to MMS usage, there are likewise risks of use, including injuries and even deaths. OBJECTIVE The aim of the current review was to summarize results from clinical studies regarding the enhancement of MMS driver safety with a primary focus on improving driving skills/performance using clinical approaches. We addressed three main objectives: (1) to identify and summarize any available evidence (strong, moderate, or weak evidence based on the quality of studies) regarding improved driving skills/performance following training/intervention; (2) to identify types of driving skills/performance that might be improved by training/intervention, and (3) to identify the use of technology in improving MMS performance or training procedure. METHODS Articles were searched for in the following medical and engineering electronic databases: PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, PsycINFO, CINAHL, ERIC, EI Compendix, IEEE Explore, and REHABDATA. Inclusion criteria included: aging adults or those with ambulatory problems, intervention or targeted training, and clinical trial. Outcomes included: MMS skills/performance. RESULTS Six articles met the inclusion criteria and are analyzed in this review. Four of the six articles contained training approaches for MMS drivers including skill trainings using real MMS inside and outside (i.e. in the community) and in a 3D virtual environment. The other two studies contain infrastructural assessments (i.e. the minimum space required for safe maneuverability of MMS users) and additional mobility assistance tools to improve maneuverability and to enhance driving performance. CONCLUSIONS RESULTS from the current review showed improved driving skills/performance by training, infrastructural assessments, and incorporating mobility assistance tools. MMS driving skills that can be improved through driver training include: weaving, negotiating with and avoiding pedestrian interference, simultaneous reading of signs and obstacle avoidance in path, level driving, forward and reverse driving, figure 8s, turning in place, crossing left slope, maneuvering down a 2-inch curb, and driving up and down inclines. However, several limitations exist in the available literature regarding evidence of improved driving skills/performance following training/intervention, such as small sample sizes, lack of control groups and statistical analysis.
Collapse
Affiliation(s)
- Nima Toosizadeh
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) and Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, College of Medicine, University of Arizona, Tucson, Ariz., USA
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness. OBJECTIVES To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to March 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers. SELECTION CRITERIA Randomised and quasi-randomised trials of virtual reality ('an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion') in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information. MAIN RESULTS We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. PRIMARY OUTCOMES results were statistically significant for arm function (standardised mean difference (SMD) 0.53, 95% confidence intervals (CI) 0.25 to 0.81 based on seven studies with 205 participants). There were no statistically significant effects for grip strength or gait speed. We were unable to determine the effect on global motor function due to insufficient numbers of comparable studies. SECONDARY OUTCOMES results were statistically significant for activities of daily living (ADL) outcome (SMD 0.81, 95% CI 0.39 to 1.22 based on three studies with 101 participants); however, we were unable to pool results for cognitive function, participation restriction and quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 34% (standard deviation (SD) 26, range 17 to 80) of participants screened were recruited. AUTHORS' CONCLUSIONS We found limited evidence that the use of virtual reality and interactive video gaming may be beneficial in improving arm function and ADL function when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength or gait speed. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term. Furthermore, there are currently very few studies evaluating the use of commercial gaming consoles (such as the Nintendo Wii).
Collapse
Affiliation(s)
- Kate E Laver
- Department of Rehabilitation and Aged Care, Flinders University, Repatriation General Hospitals, Daws Road, Daw Park, Adelaide, Australia, 5041
| | | | | | | | | |
Collapse
|
22
|
Affiliation(s)
- Kate Laver
- Department of Rehabilitation and Aged Care, Flinders University, Daw Park, South Australia, Australia
| | | | | | | |
Collapse
|
23
|
|